Provider Demographics
NPI:1396061909
Name:SUSSMAN, CARA L (LPCC-S)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DEER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9712
Mailing Address - Country:US
Mailing Address - Phone:614-306-5694
Mailing Address - Fax:419-362-7006
Practice Address - Street 1:300 DEER TRAIL RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9712
Practice Address - Country:US
Practice Address - Phone:614-306-5694
Practice Address - Fax:419-362-7006
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OH101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health